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Mood Disorders
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Madeleine A. Becker, Tal E. Weinberger, Leigh J. Ocker
In a large study utilizing a nationwide Medicaid database, pregnancies exposed to first generation antipsychotics and individual second generation antipsychotics (aripiprazole, quetiapine, olanzapine, ziprasidone and risperidone) were compared to unexposed pregnancies. No increased risk of cardiac malformations or overall congenital malformations was found for any of the individual agents, with the exception of risperidone, which demonstrated a relative risk of 1.26 for both cardiac malformations and overall congenital malformations compared to unexposed pregnancies, after correction for potential confounders, including indication. This small increase in risk with risperidone should be interpreted with caution and requires replication [157]. There is currently substantial reassuring data regarding first trimester exposure to quetiapine, olanzapine, and aripiprazole which do not suggest a clinically meaningful increased risk of teratogenicity. While no adverse outcomes are apparent from the literature, data regarding other pregnancy outcomes such as miscarriage, preterm delivery, small for gestational age, neonatal adaptation, and neurodevelopmental outcomes after perinatal second generation antipsychotic exposure are insufficient as yet to draw definitive conclusions [158, 159].
The Capgras Delusion
Published in Ragy R. Girgis, Gary Brucato, Jeffrey A. Lieberman, Understanding and Caring for People with Schizophrenia, 2020
Ragy R. Girgis, Gary Brucato, Jeffrey A. Lieberman
William’s case of tardive dyskinesia is relatively typical. His decades of use of a high-potency first-generation antipsychotic medication likely contributed to his development of tardive dyskinesia. His ability to respond to a lower dose of haloperidol was probably related to the fact that, more than 40 years after his diagnosis, he had substantially lower body weight and had a less active condition (i.e., he was in the “residual” phase of the illness). Fortunately, with the advent of the newer antipsychotic medications and the understanding that most people with schizophrenia respond well to lower doses of antipsychotic medications (1), most trainees in mental health fields rarely come into contact with individuals with tardive dyskinesia.
Autoimmune disorders that can be mistaken for viral illness
Published in Avindra Nath, Joseph R. Berger, Clinical Neurovirology, 2020
Maxwell Greene, Eric Lancaster
Symptomatic and behavioral therapies are often needed in parallel with immune and tumor therapies. In many autoimmune diseases aggression or violence, behavioral impulses or outbursts based in memory loss, or in the case of NMDAR, hallucinations, can be symptoms in need of treatment that can include antipsychotic therapy. First-generation antipsychotics (like Haldol) should be avoided because of the risk of worsening movement symptoms. Instead, we favor the second-generation antipsychotic quetiapine (Seroquel). Quetiapine is less likely to produce worsening of movement symptoms. As the underlying immune problem resolves, a taper of antipsychotic/behavioral medication should frequently be reconsidered.
Hallucinations and delusions associated with Parkinson’s disease psychosis: safety of current treatments and future directions
Published in Expert Opinion on Drug Safety, 2022
Stuart H Isaacson, Leslie Citrome
Typical (first-generation) antipsychotics ameliorate psychotic symptoms primarily by blocking postsynaptic dopamine-2 (D2) receptors. Efficacy of atypical (second-generation) antipsychotics is attributed to antagonism at both D2 receptors (often with lower receptor occupancy than with typical antipsychotics) and 5-hydroxytryptamine (5-HT) 2a receptors. It is expected that all currently available antipsychotics can reduce PDP symptoms, but tolerability concerns, especially the worsening of the motor symptoms of PD, render almost all of them difficult to use. In a recent evidence-based review conducted on behalf of the International Parkinson and Movement Disorder Society [21], identified as ‘clinically useful’ were pimavanserin and clozapine; (low-dose) quetiapine was identified as ”possibly useful” based on several small trials not demonstrating efficacy. Use of all other currently available antipsychotics to treat PDP were cautioned against because they all invariably worsen motor parkinsonism due to their potent postsynaptic D2 receptor blockade in PD patients who already have presynaptic dopamine depletion.
Repurposing antipsychotic drugs for cancer treatment: current evidence and future perspectives
Published in Expert Review of Anticancer Therapy, 2022
Georgios D. Lianos, George A. Alexiou, Stefano Rausei, Vasiliki Galani, Michail Mitsis, Athanasios P. Kyritsis
Antipsychotics are a widely used medication used to manage a plethora of psychotic disorders. We describe two generations of antipsychotics. In detail, first-generation antipsychotics, developed in the 1950s’, are dopamine receptor antagonists, also known as typical antipsychotics, while the novel, second-generation, antipsychotics also function at other receptors, including antagonizing the serotonin 2A receptors (5-HT2AR). It is reported that the first-generation drugs work by inhibiting dopaminergic neurotransmission, while second-generation drugs work by blocking D2 dopamine receptors as well as serotonin receptor antagonist action [5]. First-generation antipsychotics are associated with more extrapyramidal motor side-effects and prolactin elevation and are of lower cost, while second generation may cause weight gain and sedation.
Antipsychotic use among persons with schizophrenia in Sweden and Finland, trends and differences
Published in Nordic Journal of Psychiatry, 2021
Heidi Taipale, Arto Puranen, Ellenor Mittendorfer-Rutz, Jari Tiihonen, Antti Tanskanen, Simon Cervenka, Markku Lähteenvuo
Antipsychotics represent the cornerstone of the pharmacological treatment of schizophrenia [1]. The physician’s choice to prescribe a pharmacological treatment to the individual patient is influenced by many different aspects [2]. Apart from clinical guidelines, prescriber’s choice can also be influenced by culture [3], personal attitudes toward, for example, antipsychotic polypharmacy or high-dose antipsychotic use [2], views on whether to taper doses up slowly or go quickly for a good effect [4], and perception of patient’s preference on the treatment, for example, which are tolerable side-effects [5]. Genetics can also have an influence through population level pharmacogenetics (e.g. prevalence of ultra-rapid/ultra-slow metabolizers) [6]. Previous studies have shown an overall transition from first-generation antipsychotics to second-generation ones which carry lower risk of serious adverse effects [7]. Another trend in pharmacotherapy of schizophrenia is utilization of long-acting injectable antipsychotics (LAIs) to avoid problems caused by non-adherence, and benefits of LAI in relapse prevention [8–10].